HomeMy WebLinkAbout13151-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
Ilo....~.1.2.9,.1.3 ........ Date ........... 9.c.t.o..b.e?... 22 19 84
THIS CERTIFIES that the building ..... .A.d..d~.t.J:9 .n .................................
Location of Property ..... .6 9.0 ................ 9.r. qv. ,e, ,R,d,: ............ .Sg.u.~.h. 9.1.d' ......
House No. Street Ham/et
County Tax Map No. 1000 Section .... 0.5..1 ..... Block ..... 0.6. ........ Lot .... 0.2.5. ..........
Subdivision ....... ~ ....................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
May 14 , 19.8.4. pursuant to which Building Permit No. 13151Z
dated ..... .M.ay. ......2.1. ........... 198..4., was issued, and conforms to ail of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
Deck Addition to Existing Dwelling
The certificate is issued to ....D. QN....Z.I.E..R.A.N. ..........................................
(owner, ~e~ee-oc,te~ac~t.)
of the aforesaid building.
Suffolk County Department of Health Approval ............ ~... ~I./.A. .......................
UNDERWRITERS CERTIFICATE NO ....................... 1NJ, A .......................
Rev. 1/81
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N. Y.
BUILDING PERMIT
(THIS PEPu~AIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
13151 Z
Permission is hereby granted to: · ,-~-~..~
............ ...................
.... ~.~.~.~.~.~,~..~
~o....~-~ ~-~-.,~ .~r~..........~..~_~....
-"~'~/' "~'~ ........................................... ::'"'"7 ................................................................
at premises located ot'f ....;.~..~..(~......~..~/~---,......~..~.........--.~ ................................................
pursuont to application dated .... ~...~....~... .......... /,...~.. ............. , I02~7~'..# ond approved by the
Building Inspector.
Fee $.,,~,,,~.~.
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
,~}outhold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR k '
n and subm tted--icccb~., .... to the Building Inspec-
tor with the following; for new buildings or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual
natural or topographic features.
2.Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal).
;3.Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
5.Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty showing all property 'lines, streets, buildings and unusual natural or
topographic features.
2.Sworn statement of owner or previous owne~ as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5.00
/
2. Certificateofoccupancyonpre-existingdwelling/landuse--Pre-Existing C.O. $15.00
3. Copy of certificate of occupancy $1.00 Vacanl: ].and C.O. $ 5.00
Date ..........................
New Building ............. Old or Pre-existing Building Vacant Land
Location of Property .......................
House No. Street Ham/et
Owner or Owners of Property ..... .~... ~.~../~..~..
.:..l '
County Tax Map No. 1000 Section .... , ...... Block ........... Lot ....... ' ...
......................... ....... ..............
Permit No./~. (~./. ~--Date of Permit .~/~'././.~..~. A p p, ica n t
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Appr(Jval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate
Fee Submitted $ .~
(,~ :~ ~ ~ ~ Applicant ............. (~/~.......-----------------~.. -Z~ ..................
Rev. 10-10-78
COMMENTS
DATE
IELD
INSPECTION
OUNDATION (ts6) ,,
OUNDATION (2nd) ----------------~
·
OUGH FRAME &
PLUMBING -
NSULATION PER N. Y.
STATE ENERGY
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
~OUTHOLD, N.Y. 11971
TEL.: 765-1802
Disapproved a/c ............ .. 77..~. J'. ........ ./f .....
(Building Inspector)
APPLICATION FOR BUILDI{qG PERMIT
Received ........ ,19
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets of plans, accurate plot plan to scale. Fee according to schedule·
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit·
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection tlxroughout the work.
e. No building shall be occupied or used in whole or in part for any putpose what'ever until a Certificate of Occupancy
shall have been granted by the Building Inspector·
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.-,
............. . . .Z <. ...........
(Signature of applicant, or name, if a corporation)
(Mailing add~ess of applicant)
/
State whether applicant is owner, lessee, agent, architect, engineer, general contraclof} electrician, plumber or builder.
Name of owner of premises... ~1..~ .~. ~'/~',~,,~
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
~ Builder's License No. . .~. ?.4. ...........
Plumber's License No .........................
Electri~ian's License No... /--)O ¥ . ..
Other Trade's License No .......... '( ...........
1. Location of land on which proposed work will be done...~?..~.. ~ ~. 8.°.~.~ .... 17. .....
House Number Street Hamlet
County Tax Map No. 1000 Section .~. ..... . .x~'. f ......Block .... ~. ............ Lot....c~.,~.~'. ..........
Subdivision ........ ['7. .......................... Filed Map No ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy . . . ~ ....... ~. ~d ..........................
b. Intended use and occupancy ................ A... ~'..
k( h k hi happli bl ) N ildi ~ Additi Alt ~..
3. Natureofwor cec w c. ca e: ew Bu ng .......... on .......... eration .......
Repair .............. Removal .............. Demolition .............. Other Work ...............
4. Estimated Cost ...... · ......................... Fee ...................................
i '" (to be paid on filing this application)
/
5. If dwelilng, number of dwelhngiunlts Number of dwelling units on each floor ......
If garage, number of cars .... i ...................................................................
6. If bus]ness, commermal or mlxe,cl occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structur{s, if any: Front ............... Rear .............. Depth ...............
tteighf ............... Nm~ber of Stories ........................................................
Dimensions of same structure with alterations or additions: Front ................. Rear ..................
Depth ................... I · · Height ...................... Number of Stories ......................
8. Dimensions of entire new construct]on: Front ............... Rear ............... Depth ...............
Height ............... Number of Stones ............. ~ ..........................................
9. Size of lot: Front ........ t.~.'?f. ......... Rear .... /.I[,~ .... : .......... De~t~ ... t'.q~o.: ............
10. Date of eurchase ..~./.?.~...I .................. Name of Former Owner ...~.-).~./~'~. ...........
1 1. Zone or use district in which pr~mises are situated .....................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ................................
1 3. Will lot be regraded ........................... Will excess fill be removed from premises: Yes No
14. Name of Owner of premisesJ~/r. ~:t.~l~O..~. ........ Address ~.~J~.v~./q~.~ .... Phone No. 2 t~O'r, l.x(f41 ......
Name of Architect ....... ~t ~/. 0~-~. -~. .. Address ................. .... Phone No..~
Name of Contractor ........................ Address ................... Phone No ................
PLOT DIAGRAM
Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate ail set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and ]ndmate whether
interior or Corner lot.
STATE OF NEW YORK, !S.S
,
................ : .................... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He i~the '
i (Contractor, agent, corporate officer, etc.)
of saki owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manne~ set forth in the application filed therewith..
Sworn to before me this
.................. day o .............. ,19
Notary Public, ....... County
NOTARY PUBLIC, State o~lNew
~10 ,I?078't8. Su,01~ c0un~ (Signature of applicant) .
'x
NOTiFY-~.~L-~]NG DEPARTMEJ~F AT
765-1802 9 AM TO 4 PM ~R THE
FOLLOWING ~N?ECTIONS:
1. FOUHr;ATiON - TWO REQUIRED
FOR r..-,~ ~?.~D CONCRETE
2. ROI. lc !.- FRAMING 8~ PLUMBING
4. FIN/r .7."x"" :":','ION MuST
BE C ...... r'R C. O.
ALL CO~' - '¢'c~'3N SHALL MEET
THE REC~L;;2-,' q;N'I-S OF q'HE N.Y.
STATE CONS'I'RUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
D~IGN OR CONSTRUCTION ERRORS.
(' (